Healthcare Provider Details

I. General information

NPI: 1083806624
Provider Name (Legal Business Name): MARISA ELIZABETH DESIMONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3229 E GENESEE ST JOSLIN CENTER
SYRACUSE NY
13214-2016
US

IV. Provider business mailing address

3229 E GENESEE ST JOSLIN CENTER
SYRACUSE NY
13214-2016
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5726
  • Fax: 315-464-2500
Mailing address:
  • Phone: 315-464-5726
  • Fax: 315-464-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number261326
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: